Stages of Dementia

LEVEL 1 – NORMAL AGING
LEVEL 2 – EARLY STAGE
LEVEL 3 – MIDDLE STAGE
LEVEL 4 – MIDDLE STAGE
LEVEL 5 – LATE STAGE
LEVEL 6 – LATE STAGE
LEVEL 7 – LATE STAGE
LEVEL 1 – NORMAL AGING

Level 1 - Normal Aging

CLINICAL CHARACTERISTICS

No cognitive changes evident. Normal aging, normal brain function.

LEVEL 2 – EARLY STAGE

Level 2 - Early Stage

Mild Cognitive Impairment (MCI)
Unknown timeline, possibly from age 40 to age 55/60
Minimal brain tissue loss

CLINICAL CHARACTERISTICS

Subjective cases of memory deficits 
Recovers relatively quickly from mistakes, may correct self 
Misplaces familiar objects 
Forgets names he/she knows well 
No problems completing tasks or at social functions 
Exhibits appropriate concern over memory function 
Vacillates between seeking medical care and ignoring symptoms 
Functions effectively at work 
Highly functional social skills 
Requires complete cognitive testing to determine challenges 
Anticipate cognitive medication administration 
Scores well on orientation test, requires cognition exam for diagnosis 
Amnesia beginning to be expressed

LEVEL 3 – MIDDLE STAGE

Level 3 - Middle Stage

Beginning Dementia
Stage may be 1 - 4 years or more
Minimal brain tissue loss

CLINICAL CHARACTERISTICS

Memory deficit evident on intensive interview 
Attempts to conceal deficits 
Expresses concern regarding deficits (mild/moderate anxiety) 
Problems performing in demanding situations (work or social) 
Co-workers/family members aware of increasing challenges 
Gets lost traveling to new areas 
Exhibits signs of cognition (reading) but retains little information 
Name/word finding difficulty more frequent 
Challenged to remember new names 
Denies any cognition difficulties 
Demonstrates high social skill level 
Uses humor to avoid answering questions 
No noticeable physical changes 
Beginning to skip steps in tasks 
Able to score well on orientation test, but not on cognition exam 
At times appears befuddled 
Amnesia, aphasia, agnosia present

 

 

LEVEL 4 – MIDDLE STAGE

Level 4 - Middle Stage

Moderate Dementia
Stage may be 1 - 4 years or more
4 ounces brain tissue loss
Equivalent to 12 year old to adulthood

CLINICAL CHARACTERISTICS

Decreased knowledge of current and recent events 
Memory deficits regarding personal history 
Decreased ability to perform serial subtractions 
Difficulty with immediate recall 
Difficulty with complex tasks 
Denial of deficits, with or with out agitation and annoyance 
Withdraws from challenging situations 
Increased anxiety/frustration over abilities or loss thereof 
Difficulty telling jokes, stories 
Decreased facial affect 
Increased appearance of depressive symptoms 
Begins incorrectly identifying family members 
Fluctuation in functioning can appear great at times 
May become lost in tasks 
Greater language challenges, word-finding 
Challenges in driving/operating car 
No weight loss or physical changes in appearance 
Begins keeping lists of family names, phone numbers, etc. 
Exhibits greater desire for sweet foods 
May score well on orientation test, deficits on cognition exam 
Amnesia, Aphasia, Agnosia and Apraxia present

LEVEL 5 – LATE STAGE

Level 5 - Late Stage

Moderately Severe Dementia 
All Dressed Up, Ready To Go 
Stage may be 1-3 Years 
½ to 1 pound brain tissue loss 
Equivalent to 8 – 12 year old 
*Equivalent to 4– 8 year old

CLINICAL CHARACTERISTICS

Disorientation to time (date, day of week, season, etc.) or place 
Immediate memory relatively intact 
Needs assistance choosing clothing, layers clothing 
May crave sweets over other foods 
Denies need for assistance with ADLs/IADLs 
Hunting and Gathering Stage 
Urinary Incontinence begins –monthly to weekly to daily 
Wears clothing appropriately (hearing aid, glasses, carries purse) 
Feeds self (may need meal set-up) 
Sleep disturbances 
Can score well on an orientation test 
Wanders looking for a way out (purposeful wandering/ Sun-downing) 
Follows simple instructions for ADLs, verbal cues needed for tasks 
Unexplained tearfulness or extreme laughter 
Catastrophic reactions 
Some resistance to care giving 
*May begin chronic Urinary Tract Infections 
*Appears severely depressed 
*Increased loss of facial affect 
*Coordinated movement/function beginning to be affected 
*Begins to be lost in current time 
*Difficulty recognizing self in a mirror 
*Challenged to recall family members 
*Accuses family members, caregivers of theft, infidelity, lying 
*Automatic “yes/no” speech functions, but without understanding 
*May begin using curse words as temporal lobes become damaged 
*Changes in visual perception increasing 
*Difficulty interpreting background noise 
*Challenged to perform rehab for injuries, may appear stubborn 
*Cannot give accurate information 
*Caregivers may confuse behavior for purposeful action – lying, etc. 
*Physical appearance beginning to be affected 
*Pilling or rubbing motions common, may enjoy folding items 
*Amnesia, Aphasia, Agnosia and Apraxia evident to outsiders

LEVEL 6 – LATE STAGE

Level 6 - Late Stage

Severe Dementia 
In My Own Little World 
Stage may be 1 - 3 Years 
1 to 1½ pounds of brain tissue loss 
Equivalent to 2 – 4 year old

CLINICAL CHARACTERISTICS

Unable to recall most recent events 
Repetitiveness in motion or speech or memory 
May be in constant motion, wanders/walks for hours 
Removes/won’t wear clothing appropriately (glasses, hearing aid) 
Refuses to change clothing 
Feeds self with set-up; cues; assist 
Bowel incontinence begins 
Sleep disturbances, may increase sleep, may require little sleep 
Catastrophic reactions, great resistance to care giving, bathing 
Purposeless wandering/Sun-downing (wandering without an agenda) 
Cannot complete a two-stage command 
Apraxia advanced, gait altered (small shuffling steps) 
Aphasia increased, great language loss 
Weight loss beginning 
Difficult to engage with caregiver, challenged to initiate conversation 
Disregards eyeglasses, dentures, hearing aids (agnosia) 
Disheveled appearance 
May begin sleeping for longer periods of time 
Difficult to perform rehab for injuries 
Almost total loss of facial affect 
May suddenly use complete sentence, then only words or sounds

LEVEL 7 – LATE STAGE

Level 7 - Late Stage

Very Severe Dementia 
Bedbound 
Total Care Required 
Stage may be 1 to 2 years 
1½ to 2 pounds brain tissue loss 
Equivalent to Infants – 2 year old

CLINICAL CHARACTERISTICS

Unable to recall most recent events 
Repetitiveness in motion or speech or memory 
May be in constant motion, wanders/walks for hours 
Removes/won’t wear clothing appropriately (glasses, hearing aid) 
Refuses to change clothing 
Feeds self with set-up; cues; assist 
Bowel incontinence begins 
Sleep disturbances, may increase sleep, may require little sleep 
Catastrophic reactions, great resistance to care giving, bathing 
Purposeless wandering/Sun-downing (wandering without an agenda) 
Cannot complete a two-stage command 
Apraxia advanced, gait altered (small shuffling steps) 
Aphasia increased, great language loss 
Weight loss beginning 
Difficult to engage with caregiver, challenged to initiate conversation 
Disregards eyeglasses, dentures, hearing aids (agnosia) 
Disheveled appearance 
May begin sleeping for longer periods of time 
Difficult to perform rehab for injuries 
Almost total loss of facial affect 
May suddenly use complete sentence, then only words or sounds 
Frequently no speech at all – mostly grunting 
Cannot feed self --- Chipmonking, high choking risk 
Unable to sit up independently, unable to hold head up 
Loss of basic psychomotor skills (unable to walk w/o assistance) 
Hyper oral (may put everything in mouth) 
Requires total care, Displays great muscular flexation 
Extreme risk for skin breakdown 
Spends majority of day asleep or semi-alert 
Loss of ability to smile – indicative death is near